Table 6 Studies addressing ROTEM®® thresholds for the prediction/reduction of mortality
Study | Comparator | Optimal ROTEM®® Parameter and cut off | Accuracy of threshold | Key findings | ||
|---|---|---|---|---|---|---|
Sensitivity | Specificity | AUC | ||||
Levrat 2008 [37] | ELT < 90 min | EXTEM MCF ≤ 18 mm LI30 ≤ 71 % APTEM MCF ↑ by 7 % | 100 75 80 | 100 100 100 | 1.00 0.87 0.80 | 1 – Patients with HF had higher mortality rate (100 %, CI: 48–100 % vs. 11 % CI: 5–20 %, p < 0.05) |
Schochl 2009 [26] | No comparator | ML = 100 % | NA | NA | NA | 1 – Fulminant HF associated with 100 % mortality 2 – ↑CFT and ↓PLT contribution to MCF associated with ↑mortality (p = 0.042 and p = 0.026 respectively) |
Schochl 2010 [27] | No comparator | FIBTEM MCF < 10 mm EXTEM CT > 1.5 × normal | NA | NA | NA | 1 – Observed mortality was lower than the predicted mortality by TRISS (24.4 % vs.33.7 %, p = 0.032) with a favourable survival rate. |
Tauber, 2011 [40] | PT = 70 % FIB = 1.82 g/L | FIBTEM MCF < 7 mm, EXTEM CT 91 s EXTEM CFT 218 s EXTEM MCF 46 mm | NA | NA | 0.8 | 1 – FIBTEM MCF < 7 mm and EXTEM MCF < 45 mm associated with higher mortality (21 % vs. 9 % SCTs, p = 0.006 and 25.4 % vs. 9.4 % SCTs, p < 0.001, respectively) 2 – EXTEM MCF had strong association with early deaths (OR 0.94, 95 % CI 0.9–0.99). |
Schochl, 2011 [39] | aPTT > 35 s | FIBTEM MCF < 9 mm | NA | NA | 0.77 | 1 – Decrease in clotting times in EXTEM and INTEM (p < 0.001), decreased CFT in EXTEM and INTEM (p < 0.0001), and increased MCF in EXTEM, INTEM, and FIBTEM (p < 0.01) were noted in survivors compared with non-survivors, in patients with severe isolated TBI 2 – FIBTEM MCF (ROC 0.77, 95 % CI 0.66.5–0.85, p < 0.001) and aPTT (ROC 0.79 95 % CI 0.68–0.86, p < 0.001) independently associated with mortality. |
Rourke, 2012 [42] | FIB < 1.5 g/L | EXTEM CA5 < 36 mm FIBTEM CA5 < 10 mm | 53 78 | 87 70 | NA NA | 1 – Fibrinogen level was independently associated with higher mortality at 24 h and 28 days (p < 0.001). ROTEM could detect hypofibrinogenemia early and rapid replacement of fibrinogen may improve outcomes. |